Rickets: Causes, Symptoms and Treatments - Medical News Today Rickets: Causes, Symptoms and Treatments Written by Stephanie Brunner B.A. 4 16 Rickets is a childhood bone disorder in which bones soften and become prone to fractures and deformity. Although rare in industrialized nations, it is still fairly common in some developing countries. The main cause of rickets is a lack of vitamin D . Not having enough calcium in one's diet may also be a cause of rickets, as may vomiting and diarrhea . Some childhood kidney and liver diseases can cause rickets, as may a digestive disorder complication that affects calcium and phosphorous absorption. Rickets affects mainly children, although the disorder may also affect adults (osteomalacia). In most cases, the child suffers from severe and long-term malnutrition , usually during early childhood. The term rickets comes from the Old English word "wrickken", meaning to twist or bend. Rickets was common in the UK and USA during the 19th century. For proper absorption of calcium and phosphorous from the gut, we need vitamin D. If vitamin D levels in a child are low, he/she may have inadequate calcium and phosphorous bone levels.

A study published in JAMA in 2013 suggested that babies should be given a daily dose of vitamin D of 400 IU (international units) to help them stay healthy . Providing a child with extra vitamin D and some minerals usually resolves the rickets problem. Symptoms of rickets A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. Symptoms of rickets may include: Baby is floppy Causes of rickets Some of the conditions that can be caused by vitamin D deficiency. Lack of vitamin D - the main cause of rickets. Our bodies need vitamin D in order to absorb calcium from the intestines. Ultraviolet light (from sunlight) helps our skin cells convert vitamin D from an inactive into an active state. If we do not have enough vitamin D, calcium that we get from the food we eat is not absorbed properly, causing hypocalcemia (lower-than-normal blood calcium) to develop. Hypocalcemia results in deformities of bones and teeth, as well as neuromuscular problems.

The following foods are known to be rich on vitamin D: eggs, fish oils , margarine, some fortified milks and juices, some oily fishes, and some soymilk products that have vitamin D added. Genetic defect - hypophosphatemic rickets is a rare genetic fault that undermines the way the kidneys process phosphates. Phosphate blood levels are too low, leading to weak and soft bones. Some diseases - some renal (kidney), hepatic (liver) and intestinal diseases can interfere with the way the body absorbs and metabolizes minerals and vitamins, resulting in rickets. Risk factors for rickets Vitamin D is described as the sunshine vitamin. A study published in the journal Pharmacology and Pharmacotherapeutics in 2012 suggested that 50% of the worldwide population may be deficient in vitamin D ( source ). A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. Risk factors for rickets include: Poverty - rickets is more likely to occur among children who are poor.

Sunlight - children who do not get enough sunlight are more dependent on excellent nutrition to make sure they are getting enough vitamin D. Malnutrition - rickets is more common in areas of the world where severe droughts and starvation occur. On the next page we look at the diagnosis of rickets, complications caused by the condition and the available treatments for rickets. Rickets, Vitamin D Deficiency Rickets, Vitamin D Deficiency Important It is possible that the main title of the report Rickets, Vitamin D Deficiency is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Synonyms None General Discussion Vitamin-D deficiency rickets, a disorder that becomes apparent during infancy or childhood, is the result of insufficient amounts of vitamin D in the body. The vitamin deficiency may be caused by poor nutrition , a lack of exposure to the sun, or malabsorption syndromes in which the intestines do not adequately absorb nutrients from foods. Vitamin D is needed for the metabolism of calcium and phosphorus in the body, which, in turn affects how calcium is deposited in the bones; thus it is considered essential for proper bone development and growth.

Major symptoms of vitamin D deficiency rickets include bone disease, restlessness, and slow growth. This disorder is rare in the United States but is not uncommon in certain areas of the world. Resources NIH/National Institute of Diabetes , Digestive & Kidney Diseases Office of Communications & Public Liaison Bldg 31, Rm 9A06 31 Center Drive, MSC 2560 Bethesda, MD 20892-2560 Internet: For a Complete Report This is an abstract of a report from the National Organization for Rare Disorders (NORD). A copy of the complete report can be downloaded free from the NORD website for registered users. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational therapies (if available), and references from medical literature. For a full-text version of this topic, go to and click on Rare Disease Database under "Rare Disease Information". The information provided in this report is not intended for diagnostic purposes. It is provided for informational purposes only. NORD recommends that affected individuals seek the advice or counsel of their own personal physicians. It is possible that the title of this topic is not the name you selected.

Please check the Synonyms listing to find the alternate name(s) and Disorder Subdivision(s) covered by this report This disease entry is based upon medical information available through the date at the end of the topic. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. For additional information and assistance about rare disorders, please contact the National Organization for Rare Disorders at P.O. Box 1968, Danbury, CT 06813-1968; phone (203) 744-0100; web site or email orphan@rarediseases.org Last Updated: 4/25/2008 Rickets Causes, Symptoms,Treatments & Prevention Medical Author: David Perlstein, MD, MBA, FAAP David Perlstein, MD, MBA, FAAP Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City.

After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx. Medical Editor: William C. Shiel Jr., MD, FACP, FACR William C. Shiel Jr., MD, FACP, FACR Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. Share Your Story Rickets is a bone disorder caused by a deficiency of vitamin D, calcium, or phosphate. Rickets leads to softening and weakening of the bones and is seen most commonly in children 6-24 months of age. There are several subtypes of rickets, including hypophosphatemic rickets (vitamin-D-resistant rickets), renal or kidney rickets ( renal osteodystrophy ), and most commonly, nutritional rickets (caused by dietary deficiency of vitamin D, calcium, or phosphate).

Classic nutritional rickets is also medically termed osteomalacia. What is the history of rickets? Roman descriptions of individuals with rickets can be found as early as the second century, and in the 1640s, the condition was well documented as a common bone ailment across England. Unfortunately, the scientifically proven cause of rickets was not identified until the 1920s, and by the 1930s, public-health initiatives recommended fortifying milk with vitamin D and cod-liver oil as a nutritional supplement for young infants and children. This led to a near eradication of rickets in the United States and other industrialized nations. Unfortunately, rickets has made a comeback and is still common in less-developed nations. Moreover, for a variety of reasons, rickets is seen more frequently amongst infants and children living in industrialized nations, often among more affluent populations. Medically Reviewed by a Doctor on 3/7/2016 Rickets and osteomalacia - Causes - NHS Choices Rickets and osteomalacia - Causes Rickets Prevention Causes of rickets Rickets usually occurs because of a lack of vitamin D or calcium, although it can also be caused by a genetic defect or another health condition.

Lack of vitamin D and calcium The most common cause of rickets is a lack of vitamin D or calcium in a child's diet. Both are essential for children to develop strong and healthy bones. Sources of vitamin D are: sunlight – your skin produces vitamin D when it's exposed to the sun, and we get most of our vitamin D this way food – vitamin D is also found in some foods, such as oily fish, eggs and fortified breakfast cereals dietary supplements Calcium is commonly found in dairy products, such as milk, cheese and yoghurt, and green vegetables, such as broccoli and cabbage. Over time, a vitamin D or calcium deficiency will cause rickets in children and soft bones (osteomalacia) in adults. See preventing rickets for more information and advice about ensuring your child gets enough vitamin D and calcium. Who's at risk? Any child who doesn't get enough vitamin D or calcium can develop rickets, but there are certain groups of children who are more at risk. For example, rickets is more common in children of Asian, African-Caribbean and Middle Eastern origin because their skin is darker and needs more sunlight to get enough vitamin D.

Babies born prematurely are also at risk of developing rickets because they build up stores of vitamin D while they're in the womb. Babies who are exclusively breastfed, especially for longer than six months, may also be at risk of vitamin D deficiency. This is why the Department of Health recommends that: pregnant and breastfeeding women should consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D babies from birth to one year of age, whether exclusively or partially breastfed, should be given a daily supplement containing 8.5 to 10mcg of vitamin D, to make sure they get enough babies fed infant formula do not need a vitamin D supplement until they are receiving less than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D children aged 1 to 4 years old should be given a daily supplement containing 10mcg of vitamin D For more information, read who should take vitamin D supplements . Genetic defect Rare forms of rickets can also occur in some inherited (genetic) disorders. For example, hypophosphatemic rickets is a genetic disorder where the kidneys and bones deal abnormally with phosphate.

Phosphate binds to calcium and is what makes bones and teeth hard. This leaves too little phosphate in the blood and bones, leading to weak and soft bones. Other types of genetic rickets affect certain proteins in the body that are used by vitamin D. Underlying conditions Occasionally, rickets develops in children with rare forms of kidney, liver and intestinal conditions. These can affect the absorption of vitamins and minerals. Page last reviewed: 21/12/2015 Rickets: MedlinePlus Medical Encyclopedia Work indoors during the daylight hours You may not get enough vitamin D from your diet if you: Are lactose intolerant (have trouble digesting milk products) Do not drink milk products Follow a vegetarian diet Infants who are breastfed only may develop vitamin D deficiency. Human breast milk does not supply the proper amount of vitamin D. This can be a particular problem for darker-skinned children in winter months (when there are lower levels of sunlight). Not getting enough calcium and phosphorous in your diet can also lead to rickets. Rickets caused by a lack of these minerals in diet is rare in developed countries, because calcium and phosphorous are found in milk and green vegetables. Your genes may increase your risk of rickets.

Hereditary rickets is a form of the disease that is passed down through families. It occurs when the kidneys are unable to hold onto the mineral phosphate. Rickets may also be caused by kidney disorders that involve renal tubular acidosis . Disorders that reduce the digestion or absorption of fats will make it more difficult for vitamin D to be absorbed into the body. Occasionally, rickets may occur in children who have disorders of the liver, or who cannot convert vitamin D to its active form. Rickets is rare in the United States. It is most likely to occur in children during periods of rapid growth, when the body needs high levels of calcium and phosphate. Rickets may be seen in children ages 6 to 24 months. It is uncommon in newborns. Symptoms Urine calcium Treatment The goals of treatment are to relieve symptoms and correct the cause of the condition. The cause must be treated to prevent the disease from returning. Replacing calcium, phosphorus, or vitamin D that is lacking will eliminate most symptoms of rickets. Dietary sources of vitamin D include fish, liver, and processed milk. Exposure to moderate amounts of sunlight is encouraged.

If rickets is caused by a metabolic problem, a prescription for vitamin D supplements may be needed. Positioning or bracing may be used to reduce or prevent deformities. Some skeletal deformities may require corrective surgery. Outlook (Prognosis) The disorder may be corrected by replacing vitamin D and minerals. Laboratory values and x-rays usually improve after about 1 week, although some cases may require large doses of minerals and vitamin D. If rickets is not corrected while the child is still growing, skeletal deformities and short stature may be permanent. If it is corrected while the child is young, skeletal deformities often improve or disappear with time. Possible Complications Skeletal fractures, may occur without cause When to Contact a Medical Professional Call your child's health care provider if you notice symptoms of rickets. Prevention You can prevent rickets by making sure that your child gets enough calcium, phosphorus, and vitamin D in the diet. People who have gastrointestinal or other disorders may need to take supplements. Ask your child's health care provider. Kidney (renal) causes of poor vitamin D absorption should be treated right away. People who have renal disorders should have their calcium and phosphorus levels monitored regularly.

Genetic counseling may help people who have a family history of inherited disorders that can cause rickets. Alternative Names Osteomalacia in children; Vitamin D deficiency; Renal rickets; Hepatic rickets Images X-ray References Greenbaum LA. Rickets and hypervitaminosis D. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 48. Read More Vitamin D Council | Vitamin D and rickets Rickets Summary Rickets is a condition that affects the development of bones in children. It causes soft weak bones, which can become bowed or curved. It’s a condition that only develops in children. It’s most commonly diagnosed in children between the age of 3 and 18 months. The main signs and symptoms of rickets include a misshaped or deformed skeleton, pain, fragile bones and poor growth and development. The most common cause of rickets is an extreme lack of vitamin D or a lack of calcium, or both together.

The link between vitamin D and rickets has been known for many years and is well understood by doctors and scientists. If your child doesn’t get enough of the minerals needed to make healthy strong bones, or enough vitamin D, the bones can’t form hard outer shells. This is why they become soft and weak. The type of rickets that is caused by a lack of vitamin D and other minerals can be totally prevented by making sure your child gets enough vitamin D and calcium. Your baby can get the vitamin D he or she needs from your breast milk (as long as you’re getting good amounts yourself) or from formula milk with vitamin D added. However, if you don’t get good amounts of vitamin D yourself, your breast milk will not provide much vitamin D at all and require you to give your baby vitamin D supplements. Older children can take vitamin D supplements, or get vitamin D by exposing their skin to the sun. Research now shows that getting enough vitamin D during pregnancy is important for the health of your baby. If you’re pregnant you should consider taking a vitamin D supplement, particularly if you have darker skin or get little sunshine on your skin. Rickets can be effectively treated with vitamin D supplements.

As well as giving vitamin D, doctors may also prescribe calcium supplements to treat rickets. What is rickets? Rickets is a condition that affects the development of bones in children. It causes soft weak bones, which can become bowed or curved. Rickets is a condition that affects the development of bones in children. It causes soft weak bones, which can become bowed or curved. As you child grows up, his or her bones are continually growing and developing. How the bones develop, and how strong they are, depends on the amount of minerals such as calcium and phosphorus, that form the hard outer shell of the bones. This process is called mineralization. Calcium and phosphorus are absorbed from the food and drink your child has and end up in the bones. Your child needs vitamin D too, because it helps the body to use calcium properly, and makes sure it gets to where it’s needed (the bones or teeth). If your child doesn’t get enough of the minerals needed to make healthy strong bones, or enough vitamin D, the bones can’t form hard outer shells. They become soft and weak and as your child grows and gets heavier, the increase in their weight can cause the bones to become bowed, misshaped and deformed.

If you child has rickets, then he or she is also more likely to develop infections such as pneumonia and gastroenteritis (infection of the stomach and bowel). 1 These can be very serious in babies and young children. Babies and children with rickets may also be more likely to break (fracture) bones. 2 How common is rickets? The number of children that develop rickets in the US isn’t known. 3 However, research from the UK found that about 1 in every 100 non-Caucasian children has rickets. 4 Rickets is more common in children who have darker skin and in children who are breast fed rather than bottle fed. 5 Rickets is a condition that only develops in children. It’s most commonly diagnosed in children between the age of 3 and 18 months. 6 Adults can also develop soft bones. This condition is called osteomalacia. What are the symptoms of rickets? Rickets causes your child’s bones to become soft, weak and malformed, which can lead to bone deformities. The main signs and symptoms of rickets include: 7 A misshaped skeleton.

This can include thickening of the ankles, wrists or knees (‘knock-knees’), legs that curve outwards (‘bow legs’) or a breastbone that sticks out (‘pigeon chest’) Pain. The bones affected by rickets are often sore and painful, so your child may be reluctant to walk or may get tired easily. Fragile bones. The bones become weaker and are more likely to break. Poor growth and development. Your child’s skeleton doesn’t grow and develop properly, so he or she may be short for their age Problems with teeth, including weak tooth enamel and a delay in teeth coming through. Soft skull bones and a delay in the closing of the soft spot at the top of your baby’s head (the anterior fontanelle) What causes rickets? A severe lack of vitamin D or calcium or both can cause nutritional rickets. The most common cause of rickets is an extreme lack of vitamin D or a lack of calcium, or both together. 8 Vitamin D is produced naturally in your child’s body when bare skin is exposed to sunlight. Your child can also get vitamin D from most infant milk formulas, supplements and a small number of foods. Calcium comes from the food and drink your child has.

Milk and dairy foods are a good source of calcium as well as some green vegetables, tofu, sardines and canned salmon. Some foods such as soya and other non dairy milks, bread and breakfast cereals, have calcium added to them. Both calcium and vitamin D are essential for strong, healthy bones. If you breast feed your baby, and you don’t give a vitamin D supplement, then he or she is more likely to be lacking in vitamin D. When breastfeeding mothers don’t have high levels of vitamin D, their breast milk doesn’t contain much vitamin D and many breastfeeding women don’t get enough vitamin D themselves to pass on to their baby. Therefore children that are breastfed are more likely to develop rickets than children that are bottle fed (infant formula has vitamin D added to it). If your child eats a vegetarian or vegan diet, he or she may also be more likely to develop rickets, because they may not be getting enough calcium. 9 Rickets is more common in children with darker skins. 10 Children with African–American, Hispanic and Asian origins need to spend longer in the sun than children with fair skin to get the same amount of vitamin D.

However, children with fair skin can also develop rickets if they don’t go outside in the sunlight very often, are frequently covered up or have sunscreen on all the time. There are other types of rickets that are not caused by a lack of vitamin D or calcium, though these types of rickets are rare. Rickets can develop in children that have other health conditions such as liver disease, kidney disease or kidney failure. 11 There is also a type of rickets that is inherited (genetic). 12 These types of rickets are not treated with just vitamin D or calcium or both and need care from a doctor. What is the link between rickets and vitamin D? The link between vitamin D and rickets has been known for many years and is well understood by doctors and scientists. In the late 19th and early 20th centuries, doctors realized that taking cod liver oil, which contains vitamin D, helped to prevent and treat rickets in children. In the 1930’s vitamin D was added to infant formula milk for the first time. Since then the number of children developing rickets has fallen dramatically and rickets has become a rare disease in the United States.

However, rickets does still develop in some children and the numbers of children affected has started to rise. 13 The reasons why the number of children with rickets is rising aren’t clear. It may be because doctors are better at diagnosing it, or because immigrants are moving away from the equator where there is more sun exposure or just more undetected rickets in general. 14 Vitamin D helps your body to control calcium and phosphate levels. If the blood levels of these minerals become too low, your body produces hormones that cause calcium and phosphate to be released from the bones, so it can have the right amount in the blood. This is what leads to soft and weak bones. When you get very little vitamin D (severe vitamin D deficiency), your body may not absorb enough calcium. Hormones may start taking too much calcium from your bones; hormones that vitamin D usually keeps under control. This makes your bones soft and weak and rickets develops. What does the research say about vitamin D and rickets? The links between vitamin D and rickets are very clear and have been known for a long time, so there has been quite a lot of research in this area, compared to some other conditions.

There are also national guidelines for doctors on preventing rickets, produced by the Endocrine Society 15 and the American Academy of Pediatrics. 16 The Endocrine Society also produces guidelines on the treatment of rickets. Preventing rickets Research has shown that the type of rickets that is caused by a lack of vitamin D and other minerals can be totally prevented by making sure your child gets enough vitamin D and calcium. 17 Vitamin D for babies and children To develop their guidelines on preventing rickets, The American Academy of Pediatrics searched for all of the research carried out in the US, and the rest of the world, about rickets and vitamin D. Having looked at all the research and analysed it, the Academy has said that to prevent rickets, infants, children and adolescents need to have at least 400 IU of vitamin D a day. They recommend that: Babies that are being breastfed or partly breastfed should have a vitamin D supplement of 400 IU a day. Babies should keep having a supplement until they are drinking at least one litre of whole milk or formula milk a day (children shouldn’t drink whole milk until they are over one year old).

All babies and children drinking less than one litre of infant formula or whole milk a day should also take a supplement of 400 IU of vitamin D each day. Adolescents who don’t get enough vitamin D from fortified milk or foods should take a vitamin D supplement of 400 IU a day. Giving babies and children vitamin D supplements has been preventing rickets for many years. However, there isn’t much research that has looked at whether the amount that babies and children are given is actually the right amount. For example, doctors used to recommend that babies and children should have 200 IU vitamin D a day to prevent rickets, and this worked. 18 Guidelines in Canada recommend that babies should be given 400 IU a day, but that this should with increase to 800 IU a day in the winter months for babies living in the north of the country. 19 The Endocrine Society in the US recommends that infants and children should have 400IU or 600 IU of vitamin D a day, and that to get the best effect from vitamin D, they may need as much as 1,000 IU a day.

20 What the Vitamin D Council says The Vitamin D Council recommends that infants have 1,000 IU per day and children have 1,000 IU a day per 25lbs of their body weight. Breast milk can provide most or all of this for infants, if the mother is getting enough vitamin D herself. If she isn’t, then breast milk cannot provide much of the 1,000 IU a day requirement. See our breastfeeding page for more information. More research is needed to say exactly how much vitamin D is needed to prevent rickets. However, that research may never come. Something else that researchers and doctors also have to take into account is whether the amount of vitamin D children get is enough to meet other health needs, as well as to prevent rickets. The amount of vitamin D children need for other health reasons may be higher than what is needed to prevent rickets, though again, more research is needed. Vitamin D in pregnancy Some researchers have explored whether the amount of vitamin D a mother gets when she is pregnant may help to prevent rickets in her child. How much vitamin D a woman has in her body decides how much vitamin D her baby will have when he or she is born.

If you’re very deficient (lacking) in vitamin D when you’re pregnant, then your child is more likely to develop rickets. 21 Women who have darker skin and women who don’t expose their skin much to the sun are more likely to be deficient in vitamin D. 22 Research now shows that getting enough vitamin D during pregnancy is important for the health of your baby. 23 Therefore, the American Academy of Paediatrics recommends that doctors and midwives should consider giving vitamin D supplements to pregnant women who might be deficient. 24 The Endocrine Society and the Vitamin D Council suggest that all pregnant women need to take vitamin D supplements. Vitamin D and calcium Researchers have also explored the role of calcium and vitamin D in preventing rickets. Vitamin D helps calcium to work properly in your body and your body needs both to develop strong healthy bones. Research shows that babies and children who don’t get enough calcium from the food and milk they have, are more likely to develop rickets. 25 Treating rickets If your child has rickets, your doctor may choose to treat your child’s rickets with a one-time vitamin D supplement or a daily supplement.

Rickets has been treated successfully with vitamin D since at least the 1930s, when doctors gave children one very large amount of vitamin D to treat the condition. 26 Now, there is agreement among doctors that rickets should be treated with vitamin D supplements. This can either be given as one large amount, as weekly amounts or as small amounts given every day for two to three months. 27 More recent research has also looked at whether giving children a large amount of vitamin D just once is effective at treating rickets. Researchers have given children large amounts such as 200,000 or 600,000IU vitamin D in one day and found that it was a safe and effective treatment. 28 , 29 This type of treatment is called Stoss Therapy. Some scientists suggest that rickets should be treated with 5,000 to 15,000 IU of vitamin D a day for three to four weeks and then a smaller dose thereafter. 30 Talk to your doctor about which type of treatment is best for your child; one large supplement, weekly or daily supplements. As well as giving vitamin D, doctors may also prescribe calcium supplements to treat rickets.

31 Key points from research The links between vitamin D and rickets are very clear and have been known for a long time. There are many national guidelines, including a number in the US, which tell doctors how to prevent rickets. These guidelines have been developed by reading and analyzing all of the research on vitamin D and rickets. Rickets can be prevented by making sure your child gets enough vitamin D and calcium. Babies that are breastfed or partly breastfed should be given a vitamin D supplement, unless the breastfeeding mother gets good amounts of vitamin D herself. Doctors and researchers haven’t come to a definite answer about how much vitamin D supplement is enough to prevent rickets and ensure good bone health. However, it is likely at least 400 IU a day. It’s important for the health of a baby for the mother to get enough vitamin D while she is pregnant. Research suggests that women who are more likely to be deficient in vitamin D during their pregnancy should take a vitamin D supplement to prevent rickets in their child. Babies and children who don’t get enough calcium from the food and milk they have, are more likely to develop rickets Rickets can be treated successfully with vitamin D, calcium or sometimes both.

What does this mean for me? Good vitamin D and calcium nutrition can prevent nutritional rickets and help your child grow strong and healthy. If you’re pregnant you should consider taking a vitamin D supplement, particularly if you have darker skin or get little sunshine on your skin. The Vitamin D Council recommends taking 4,000 IU to 6,000 IU of vitamin D every day if you’re pregnant. Other organizations in the United States have set different recommended daily amounts, usually much lower. For example, the Food and Nutrition Board recommend 600 IU of vitamin D every day because they feel there is not enough research at this time to recommend higher amounts. You can find out more about vitamin D when you’re pregnant by going to our Vitamin D during pregnancy and breastfeeding page . If you’re breastfeeding your baby, either fully or in part, you may need to give your baby a vitamin D supplement every day. If you’re getting enough vitamin D, your baby should be getting enough vitamin D from your milk. However, many women don’t get enough vitamin D and if that is the case, you will need to give your baby a supplement. Not all organizations recommend the same amount of supplement for babies each day.

Here is a list of the current recommendations from organizations in the United States: Vitamin D Council 1,000 IU/day* Endocrine Society 400-1,000 IU/day Food and Nutrition Board 400 IU/day You can find out more about vitamin D when you’re breastfeeding by going to our Vitamin D during pregnancy and breastfeeding page . If you’re giving your baby only infant formula, which contains vitamin D, you may not need to give a supplement. Older children and adolescents also need enough vitamin D to keep their bones healthy and prevent rickets. If your child isn’t able to get vitamin D from being out in the sun, you should give him or her vitamin D supplements. You can find out more by going to our Vitamin D during pregnancy and breastfeeding page . References Y Cesur, M Dogan, S Ariyuca etc al. Evaluation of children with nutritional rickets. J Pediatr Endocr Met 2011;24(1-2):35-43 Winzenberg T, Jones G. Vitamin D and bone health in childhood and adolescence.

Calcif Tissue Int (2013) 92:140-150 Thatcher T, Fischer P, Tebben P et al. Increasing Incidence of Nutritional Rickets: A population-based study in Olmsted County Minnesota. Mayo Clinic Proc 2013; 88(2):176-183 Ashraf S, Mughal MZ ; The prevalence of rickets among non-Caucasian children. Arch Dis Child. 2002 Sep;87(3):263-4. Rickets. eMedicine. Shah BR, Finberg L. Single-day therapy for nutritional vitamin D-deficiency rickets: a preferred method. J Pediatr. Sep 1994;125(3):487-90. Billoo AG, Murtaza G, Memon MA et al. Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets, J Coll Physicians Surg Pak. 2009: 19: 428-431. Pettifor JM. Vitamin D Deficiency and Nutritional Rickets in Children.

In Vitamin D: Third Edition by Feldman D, Pike JW and Adams JS. Elsevier Academic Press, 2011. Rickets. American Academy of Orthopaedic Surgeons. This page in PDF format Are you a health care provider? Print and share this PDF file to your patients: This page was last updated August 2014. We need your help! vitamin D-dependent rickets - Genetics Home Reference vitamin D-dependent rickets Description Vitamin D-dependent rickets is a disorder of bone development that leads to softening and weakening of the bones (rickets). The condition is split into two major types: type 1 (VDDR1), which is also known as pseudovitamin D deficiency rickets or vitamin D 1α-hydroxylase deficiency, and type 2 (VDDR2), also known as hereditary vitamin D-resistant rickets (HVDRR). The signs and symptoms of this condition begin within months of birth, and most are the same for VDDR1 and VDDR2. The weak bones often cause bone pain and delayed growth and have a tendency to fracture. When affected children begin to walk, they may develop bowed legs because the bones are too weak to bear weight.

Impaired bone development also results in widening of the areas near the ends of bones where new bone forms (metaphyses), especially in the knees, wrists, and ribs. Some people with vitamin D-dependent rickets have dental abnormalities such as thin tooth enamel and frequent cavities. Poor muscle tone (hypotonia) and muscle weakness are also common in this condition, and some affected individuals develop seizures. In vitamin D-dependent rickets, there is an imbalance of certain substances in the blood. Both VDDR1 and VDDR2 are characterized by low levels of the minerals calcium (hypocalcemia) and phosphate (hypophosphatemia), which are essential for the normal formation of bones and teeth. Affected individuals also have high levels of a hormone involved in regulating calcium levels called parathyroid hormone (PTH), which leads to a condition called secondary hyperparathyroidism. The two forms of vitamin D-dependent rickets can be distinguished by blood levels of a hormone called calcitriol, which is the active form of vitamin D; individuals with VDDR1 have abnormally low levels of calcitriol and individuals with VDDR2 have abnormally high levels.

Hair loss ( alopecia ) can occur in VDDR2, although not everyone with this form of the condition has alopecia. Affected individuals can have sparse or patchy hair or no hair at all on their heads. Some affected individuals are missing body hair as well. Frequency Rickets affects an estimated 1 in 200,000 children. The condition is most often caused by a lack of vitamin D in the diet or insufficient sun exposure rather than genetic mutations; genetic forms of rickets, including VDDR1 and VDDR2, are much less common. The prevalence of VDDR1 and VDDR2 is unknown. VDDR1 is more common in the French Canadian population than in other populations. Related Information Genetic Changes The two types of vitamin D-dependent rickets have different genetic causes: CYP27B1 gene mutations cause VDDR1, and VDR gene mutations cause VDDR2. Both genes are involved in the body's response to vitamin D, an important vitamin that can be can be acquired from foods in the diet or made by the body with the help of sunlight. Vitamin D helps maintain the proper balance of several minerals in the body, including calcium and phosphate.

One of vitamin D's major roles is to control the absorption of calcium and phosphate from the intestines into the bloodstream. The CYP27B1 gene provides instructions for making an enzyme called 1-alpha-hydroxylase (1α-hydroxylase). This enzyme carries out the final reaction to convert vitamin D to its active form, calcitriol. Once converted, calcitriol attaches (binds) to a protein called vitamin D receptor (VDR), which is produced from the VDR gene. The resulting calcitriol-VDR complex then binds to particular regions of DNA and regulates the activity of vitamin D-responsive genes. By turning these genes on or off, VDR helps control the absorption of calcium and phosphate and other processes that regulate calcium levels in the body. VDR is also involved in hair growth through a process that does not require calcitriol binding. Mutations in either of these genes prevent the body from responding to vitamin D. CYP27B1 gene mutations reduce or eliminate 1α-hydroxylase activity, which means vitamin D is not converted to its active form. The absence of calcitriol means vitamin D-responsive genes are not turned on (activated).

VDR gene mutations alter the vitamin D receptor so that it cannot regulate gene activity, regardless of the presence of calcitriol in the body; often the altered receptor cannot interact with calcitriol or with DNA. Without activation of vitamin D-responsive genes, absorption of calcium and phosphate falls, leading to hypocalcemia and hypophosphatemia. The lack of calcium and phosphate slows the deposition of these minerals in developing bones (bone mineralization), which leads to soft, weak bones and other features of vitamin D-dependent rickets. Low levels of calcium stimulate production of PTH, resulting in secondary hyperparathyroidism; hypocalcemia can also cause muscle weakness and seizures in individuals with vitamin D-dependent rickets. Certain abnormalities in the VDR protein also impair hair growth, causing alopecia in some people with VDDR2. Nutritional rickets: deficiency of vitamin D, calcium, or both? - PubMed - NCBI Nutritional rickets: deficiency of vitamin D, calcium, or both? 1Medical Research Council Mineral Metabolism Research Unit, Department of Paediatrics, Chris Hani Baragwanath Hospital and the University of the Witwatersrand, Johannesburg, South Africa.

pettiforjm@medicine.wits.ac.za Abstract Nutritional rickets remains a public health problem in many countries, despite dramatic declines in the prevalence of the condition in many developed countries since the discoveries of vitamin D and the role of ultraviolet light in prevention. The disease continues to be problematic among infants in many communities, especially among infants who are exclusively breast-fed, infants and children of dark-skinned immigrants living in temperate climates, infants and their mothers in the Middle East, and infants and children in many developing countries in the tropics and subtropics, such as Nigeria, Ethiopia, Yemen, and Bangladesh. Vitamin D deficiency remains the major cause of rickets among young infants in most countries, because breast milk is low in vitamin D and its metabolites and social and religious customs and/or climatic conditions often prevent adequate ultraviolet light exposure. In sunny countries such as Nigeria, South Africa, and Bangladesh, such factors do not apply. Studies indicated that the disease occurs among older toddlers and children and probably is attributable to low dietary calcium intakes, which are characteristic of cereal-based diets with limited variety and little access to dairy products. In such situations, calcium supplements alone result in healing of the bone disease.

Studies among Asian children and African American toddlers suggested that low dietary calcium intakes result in increased catabolism of vitamin D and the development of vitamin D deficiency and rickets. Dietary calcium deficiency and vitamin D deficiency represent 2 ends of the spectrum for the pathogenesis of nutritional rickets, with a combination of the 2 in the middle. PMID:

Question: A deficiency of which vitamin is the predominant cause of rickets?
Answer: D